The Pharmaceutical Journal
Vol 269 No 7208 p122
27 July 2002

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Ovarian cancer treatment for second-line use endorsed by NICE

Pegylated liposomal doxorubicin hydrochloride (PLDH, Caelyx) should be considered as a second-line (or subsequent) treatment option for women with advanced ovarian cancer, the National Institute for Clinical Excellence has recommended.

In its guidance issued to the National Health Service in England and Wales this week, NICE says that PLDH should be considered if the cancer is initially resistant or refractory to first-line platinum-based combination therapy or has become resistant after successive cycles of platinum-based combination therapy.

The guidance states that PLDH is not recommended for women with condition-related poor health and it does not recommend PLDH for women whose bowel is blocked because of the cancer or for those who have already been treated with PLDH but have not responded to treatment.

NICE adds that treatment with PLDH should be stopped if disease progression occurs. Stopping treatment should also be considered if there is a reduction in a woman's overall health.

In August last year, NICE issued guidance on the use of topotecan (Hycamtin), also as a second-line treatment for ovarian cancer (PJ, 11 August 2001, p185). Anne-Toni Rodgers, communications director, NICE, commented that in the guidance on PLDH, the appraisal committee has concluded that both PLDH and topotecan are clinically effective options for second-line treatment. However, the committee considered PLDH to be "probably somewhat cheaper than topotecan, and, considering together clinical- and cost-effectiveness, ease of administration and side effect profile, PLDH is likely to be the drug of choice for many women," she said.

However, the committee also noted that topotecan and PLDH have different side effect profiles. Ms Rodgers added that although doctors now have the option to use PLDH "it is important not to raise unreasonable expectations among women with ovarian cancer as neither PLDH nor topotecan show any promise for cure".

Joanne Rule, chief executive, CancerBACUP, welcoming the guidance, said: "The NHS now has a responsibility to patients to implement the guidance as quickly as possible and to make the funding available." The guidance, which will be reviewed in April 2003, is available on the NICE website (www.nice.org.uk).